par John R. Fischer
, Senior Reporter | November 25, 2019
From the November 2019 issue of HealthCare Business News magazine
“Teleradiology may have contributed to governmental agencies driving down reimbursement in some respects,” he said. “Radiologists started to do more and more volumes in the teleradiology setting, and the effect has translated to the non-teleradiology setting where radiologists are also reading faster. There has to be a limit, because you need to spend a certain amount of time reading films, especially ones of complex cases, in order to be reimbursed fairly.”
The same can be said for AI. “AI can be done in so many different ways that we would run out of CPT codes before we have all the different software packages of algorithms there,” said Schoppe. “What is going to happen, in my opinion, is that we will get paid for it in the same way that voice recognition software gets paid for, usually on a per-fee basis.”
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Reimbursement in general is a challenge for radiologists, due to the shift in healthcare from fee-for-service to value-based care and the bundling of relative value units for services. As a result, many practices have resorted to consolidating with one another to pool together their resources. While some proposals for alternative care models have been discussed to provide the same services at lower costs, many are cautious about bringing them to the attention of policy makers.
“Any alternative payment model requires a very detailed and granular understanding of the nuances of the specialty,” said Schoppe, who also chairs the reimbursement committee for the American College of Radiology. “When you get non-clinical people now editing a model, it runs the risk of being illogical or disadvantageous for the patients or the physicians.”
But efforts are underway to address all these issues facing the radiology community, with radiology leadership employing programs and training to help radiologists focus on more enterprise level issues that affect patients and providers themselves such as patient satisfaction, value-based care, and utilization management.
“The radiology group that has the best patient-centric technology and culture is going to succeed. That means treating the patient well,” said Shah. “Patients are going to access their reports. They have to be treated as a consumer with choices, because they will have choices. They are going to want to be empowered, to know their radiological findings are on the report, and what they mean for their health.”
Achieving this requires a combination of technological solutions and a fundamental change in the culture and communication patterns between radiologists and referring healthcare providers. Siegel, who is currently chair of the image exchange committee of CRISP, a regional health information exchange that includes hospitals in the Chesapeake Bay Area, sees such interoperability emerging rapidly over the next decade.